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End Of Life Care Can Be Different For Veterans


Half of the men who die every day in the U.S. are veterans. That's according to the Department of Veterans Affairs, and it's not as shocking as it sounds. Millions of Americans who served in World War II and in Korea are now in their 80s and 90s. Vietnam veterans are now reaching their 70s. As a result the VA is spending a lot more on what's called end-of-life care. As NPR's Quil Lawrence reports, the treatment can be different for those who've seen war.

JOSEPH O'NEIL: My name is Thomas Joseph O'Neil. I was in the U.S. Army in Vietnam '66 to '67.

QUIL LAWRENCE, BYLINE: O'Neil used to think about Vietnam constantly. He spent a year near the Mekong Delta at a time when that war was killing more Americans in a year than the total casualties from Iraq and Afghanistan combined.

O'NEIL: The only good thing was the night time because you knew another day was gone and you was closer to coming home. To be honest with you, I was a scared. I was very scared the whole year. And I don't think I’m the only one. I mean, maybe I'll admit it and other guys won’t.

LAWRENCE: When he came home, he didn't talk to anyone about the war. O'Neil says he nearly drank himself into the grave. In 2011, he finally came to the VA to treat the PTSD he'd been enduring for 40 years. Last year, he learned he has terminal cancer. O'Neil says the staff at the VA in Queens, New York, have been helping him deal with the pain and be at peace.

O'NEIL: I think they call it end-of-life care. But whatever it is, I mean, it's unbelievable. They treat you like gold - like, you know, really, if you're going to be sick, this is the place to be.

ALICE BEAL: Our goal is - in hospice is to make life as good as it can be for as long as it can be.

LAWRENCE: Doctor Alice Beal is director of VA palliative care for most of New York City. That usually means focusing on relieving pain for the last weeks or month of life. She says it can be different for vets.

BEAL: If a veteran's been in combat, a veteran's likely to have killed. And I think no matter what your culture is, when you meet your maker - even if it's been to save your buddy, to save your life, to save your country - it's just a burden that the rest of us haven't even thought of.

LAWRENCE: If you've had blood on your hands, it comes up. People who have PTSD may have not had it unmasked their whole life. But as they're dying, all of a suddenly they get flashbacks.

LAWRENCE: The ward is a contradiction. It's brightly decorated. At the entrance, there's a fish tank and an electric fireplace. But there's usually a room just vacated with an American flag draped on the bed and a lantern on the nightstand honoring a veteran who passed on.

BEAL: There were two deaths over the weekend. And it's a real toss-up between respect and release. Around here, we tend to be full of life, but you don't want to be too joyful in the presence of a family who is grieving.

LAWRENCE: If a vet doesn't have family coming, someone from the staff will spend their final hours bedside. No veteran dies alone. Tom O'Neil, the Vietnam vet, is 68 is old - no kids. He says he doesn't want to be a burden on his family. He'd rather stay here.

O'NEIL: Once in a while I get scared - like when I have a breathing attack. You know, I'm used to being a halfway strong guy, and now I feel like I'm depending on others to help me out. Like, you know, like the nurses get mad because I try to do it myself, and they say don't do that. Don't do that. Like, you know, I guess it's ingrained in me - like, you know?

LAWRENCE: O'Neil doesn't like crowded places which he blames on PTSD. Other than the doctors and nurses, he doesn't see many people. He even asked if he could get his meals in his room. It's a corner room with lots of light. That's where he's going to spend the rest of his time.

O'NEIL: I don't think it'll be too long anyway. I never really asked to be honest with you how long. I don't think that - no offense to the doctors, but I don't think the doctors really know. So whenever the good Lord wants me - I hope he does anyway - like I came to terms with this. I'm not happy with the diagnosis, but I came to terms with it.

LAWRENCE: Quil Lawrence, NPR News. Transcript provided by NPR, Copyright NPR.

Quil Lawrence is a New York-based correspondent for NPR News, covering veterans' issues nationwide. He won a Robert F. Kennedy Award for his coverage of American veterans and a Gracie Award for coverage of female combat veterans. In 2019 Iraq and Afghanistan Veterans of America honored Quil with its IAVA Salutes Award for Leadership in Journalism.
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